Impact of Dialysis on 30-Day Outcomes After Spinal Fusion Surgery for Pathologic Fractures: Insights from a National Quality Registry.
Aged
Cervical Vertebrae
/ injuries
Cohort Studies
Databases, Factual
/ trends
Female
Humans
Length of Stay
/ trends
Lumbar Vertebrae
/ injuries
Male
Middle Aged
Registries
Renal Dialysis
/ adverse effects
Retrospective Studies
Spinal Fractures
/ pathology
Spinal Fusion
/ adverse effects
Time Factors
Treatment Outcome
Cervical
Dialysis
Fusion
Lumbar
NSQIP
Spine
Surgery
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
29
05
2019
revised:
30
06
2019
accepted:
01
07
2019
pubmed:
12
7
2019
medline:
22
1
2020
entrez:
12
7
2019
Statut:
ppublish
Résumé
Patients with chronic renal failure undergoing hemodialysis have been shown to have poor overall health, osteoporosis, and altered bone metabolism. However, the impact of hemodialysis on patient outcomes after spinal fusion remains unknown. We sought to assess the effect of dialysis on 30-day perioperative and postoperative outcomes after cervical and lumbar fusion for pathologic compression fractures. We queried the National Surgical Quality Improvement Program from 2009 to 2016 for patients undergoing cervical or lumbar fusion for compression fractures. Three-to-one propensity score matching using sex, age, body mass index, and number of operated levels was used to match patients not undergoing dialysis with those undergoing dialysis. Multivariable conditional regression was used to identify the association between dialysis and 30-day clinical outcomes, after adjusting for confounders. A total of 48,492 patients undergoing cervical fusion were identified; 156 (0.32%) of these were on dialysis. On multivariable regression, dialysis dependency was associated with increased operative time (regression coefficient [coef.], 15.93; 95% CI, 0.4-31.5; P = 0.045), length of stay (coef. 6.06; 95% CI, 4.64-7.48; P < 0.001), 30-day readmissions (odds ratio [OR], 1.07; 95% CI, 1.02-1.12; P = 0.009), any complications (OR 1.08; 95% CI, 1.03-1.13; P = 0.002), and serious complications (OR, 1.08; 95% CI, 1.02-1.14; P = 0.012). A total of 25,417 patients undergoing lumbar fusion were identified; 51 of these (0.2%) were on dialysis. On multivariable regression, dialysis dependency was associated with significantly higher length of stay (coef. 2.98; 95% CI, 1.28-4.68; P < 0.001). Our analyses indicated that dialysis dependency is associated with poor perioperative and postoperative outcomes after cervical/lumbar fusion for pathologic compression fractures.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with chronic renal failure undergoing hemodialysis have been shown to have poor overall health, osteoporosis, and altered bone metabolism. However, the impact of hemodialysis on patient outcomes after spinal fusion remains unknown. We sought to assess the effect of dialysis on 30-day perioperative and postoperative outcomes after cervical and lumbar fusion for pathologic compression fractures.
METHODS
METHODS
We queried the National Surgical Quality Improvement Program from 2009 to 2016 for patients undergoing cervical or lumbar fusion for compression fractures. Three-to-one propensity score matching using sex, age, body mass index, and number of operated levels was used to match patients not undergoing dialysis with those undergoing dialysis. Multivariable conditional regression was used to identify the association between dialysis and 30-day clinical outcomes, after adjusting for confounders.
RESULTS
RESULTS
A total of 48,492 patients undergoing cervical fusion were identified; 156 (0.32%) of these were on dialysis. On multivariable regression, dialysis dependency was associated with increased operative time (regression coefficient [coef.], 15.93; 95% CI, 0.4-31.5; P = 0.045), length of stay (coef. 6.06; 95% CI, 4.64-7.48; P < 0.001), 30-day readmissions (odds ratio [OR], 1.07; 95% CI, 1.02-1.12; P = 0.009), any complications (OR 1.08; 95% CI, 1.03-1.13; P = 0.002), and serious complications (OR, 1.08; 95% CI, 1.02-1.14; P = 0.012). A total of 25,417 patients undergoing lumbar fusion were identified; 51 of these (0.2%) were on dialysis. On multivariable regression, dialysis dependency was associated with significantly higher length of stay (coef. 2.98; 95% CI, 1.28-4.68; P < 0.001).
CONCLUSIONS
CONCLUSIONS
Our analyses indicated that dialysis dependency is associated with poor perioperative and postoperative outcomes after cervical/lumbar fusion for pathologic compression fractures.
Identifiants
pubmed: 31295605
pii: S1878-8750(19)31917-5
doi: 10.1016/j.wneu.2019.07.021
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e862-e873Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.